On Monday, Gloria J. Sawyer, aged 54, of Raleigh pleaded guilty to five felony counts of Obtaining Property by False Pretenses for defrauding the Medicaid program of at least $483,791.47 through false billings by her business, I Believe in Miracles. Wake County Superior Court Judge Donald W. Stephens sentenced her to a 16-20 month active prison sentence and ordered her to repay the money to the Medicaid program from her work release earnings.

Sawyer was one of nine North Carolina health care providers arrested last December as part of a statewide Medicaid fraud sweep. The case against Sawyer was investigated and prosecuted by Cooper’s Medicaid Investigations Division, which is made up of attorneys, financial investigators and State Bureau of Investigation agents.

Investigators determined that Sawyer concealed her prior criminal history in order to obtain a Medicaid Provider number for I Believe in Miracles, which provide Case Management Services to Medicaid recipients infected with HIV. She went on to bill Medicaid for more than $82,000 in 2009, more than $300,000 in 2010, and more than $92,000 in 2011.

The MID began looking into Sawyer’s billing practices in September 2011 based on a tip from a Medicaid recipient. The tipster told the North Carolina Division of Medical Assistance, Program Integrity Section (DMA) that I Believe in Miracles had billed Medicaid for services that she had not actually received.

The investigation revealed that Sawyer’s company did not provide many of the services for which she was paid, or that the services were provided to patients who did not have HIV. HIV case management is designed to provide eligible patients with medically necessary services to enhance their health and ability to function. Investigators discovered a system of fraud in which Sawyer directed employees to create false documents and to back date service notes in an attempt to conceal the fraud.

North Carolina’s MID has recouped more than $500 million over the past decade through cases like this one and helped convict hundreds of individuals on criminal charges including patient abuse and neglect as well as financial fraud. During the state fiscal year that ended June 30, 2013, the MID won 32 criminal convictions and 19 civil settlements that recovered $92,964,814.56 from Medicaid abusers.

The MID investigates fraud and abuse of Medicaid benefits by hospitals, doctors, pharmaceutical companies, medical equipment companies, mental health and personal care providers, ambulance services and others. The division also investigates patient abuse and neglect in nursing homes and other facilities that receive Medicaid funds. The unit works closely with United States Attorneys, District Attorneys, and other state and federal law enforcement agencies.

Assistant Attorney General Erica Bing prosecuted the case with assistance from the SBI and the DMA.